Health Information Management

Tip of the week: Ensure accurate coding of injections

APCs Insider, May 30, 2008

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Report code 90772 (therapeutic, prophylactic or diagnostic injection; subcutaneous of intramuscular) for singly prepared injections. The rule for the same and different drugs does not apply to code 90772.

Due to medically unlikely edits (MUE), providers have experienced submission problems with code 90772 when they report seven units on the same date of service. However, the NCCI made a correction available as of April 1.

Meanwhile, communicate this issue with your revenue cycle committee and speak with your fiscal intermediary. Monitor outpatient claims to ensure that you are being properly reimbursed for the units of service you report. If you have experienced any denials since January 1, note that a letter from NCCI states that it has corrected a few of the MUEs that were causing issues with line item denials and that providers may resubmit the claims after April 1 retroactively to January 1. The letter states the following:

To assist in answering your inquiry, the following information specific to the codes to which you refer is provided:

90761, 90766, and 90772—The MUEs for CPT codes 90761, 90766, and 90772 billed to the Fiscal Intermediaries will be increased on April 1, 2008, retroactive to the original effective date of January 1, 2008. A provider may choose to resubmit the claim lines, which have been “returned to the provider” for these codes after April 1, 2008. The values for the revised MUEs for these codes cannot be provided. MUEs are confidential and are only for the use of CMS and CMS contractors. CMS has not authorized the release of MUEs to the general public or other organizations.

CPT guidelines stated prior to January 1 that you should only report one IV push per drug or substance, regardless of the number of injections of the same drug administered.

In January, CPT issued code 90776 (therapeutic, prophylactic, or diagnostic injection; each additional sequential IV push of the same substance/drug provided in a facility). Parenthetical notes state that you should not report 90776 for a push performed within 30 minutes of an already reported push of the same substance or drug.

According to the AMA directives on file, reporting code 90776 depends on how the drugs are prepared and administered. Report multiple, individually prepared administrations as individual administrations. However, if the drug or substance is prepared one time and administered in portions, report the administrations as only one administration (e.g., code 90774). If the clinician administers a second, separately prepared same drug in portions, this would constitute a single administration of the same drug beyond a 30-minute interval. Report this service using add-on code 90776.

We encourage you to speak with your facility’s pharmacy and your department to determine how pushes are prepared for your facility and develop a policy and procedure to that effect. Unfortunately, medical record documentation by the clinicians does not easily allow a coder to determine whether the IV pushes were individually prepared or administered in portions.

(The above tip was excerpted from the June issue of APC Answer Letter)

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